The principles of differentiated thyroid cancer surgery and anesthesia in pregnancy: three case reports

Yıl 2015, Cilt: 25 Sayı: 6, 350 - 356, 30.12.2015

Ömer Bayır Reyhan Polat Güleser Saylam Bülent Öcal Erman Çakal Tuncay Delibaşı Mehmet Hakan Korkmaz

Öz

Development of thyroid nodule during pregnancy is rare, however the cancer rate of this nodule is high. Herein, we present medical outcomes of three pregnant women who were operated with the diagnosis of differentiated thyroid carcinoma in the light of literature. As sonographic findings of three cases showed malignant characteristics, fine needle aspiration biopsy FNAB was performed. Cytological examination result was reported as papillary thyroid carcinoma PTC . Surgery was performed in the second trimester in all cases. One case underwent total thyroidectomy with neck dissection at level III and VI and two cases underwent total thyroidectomy with neck dissection at level VI. Pathological examination result was also reported as PTC. Lymph node metastases in the dissected materials were detected. During the intraoperative and early postoperative period, no complications occurred and no findings of recurrence or residues were observed during one-year follow-up following surgery. In conclusion, as the first trimester has an increased risk of congenital malformations, elective surgery should be performed at the second trimester, if applicable. In pregnants with malignant sonographic features and PTC confirmed by FNAB, surgery can be applied safely by taking precautions during pre-/peri- and postoperative period. These patients should not be given premedication for anesthesia, should be properly positioned and teratogenic agents should be avoided. After surgery, mother and fetus should be monitored closely.

Anahtar Kelimeler

Differentiated thyroid cancer, pregnancy, thyroid surgery

Gebelikte diferansiye tiroid kanseri cerrahisi ve anestezi ilkeleri: Üç olgu sunumu

Öz

Gebelikte tiroid nodülü gelişmesi nadirdir ancak bu nodülün kanser olma oranı yüksektir. Bu yazıda, diferansiye tiroid karsinomu tanısıyla ameliyat edilen üç gebe kadının tıbbi sonuçları literatür eşliğinde sunuldu. Üç olgunun ultrason bulguları malign özellikler içermesi nedeniyle, ince iğne aspirasyon biyopsisi İİAB yapıldı. Sitolojik inceleme sonucu papiller tiroid karsinom PTK olarak bildirildi. Tüm olgularda cerrahi ikinci trimesterde gerçekleştirildi. Bir olgumuza total tiroidektomi ile birlikte seviye III ve seviye VI boyun diseksiyonu ve iki olguya total tiroidektomi ile seviye VI boyun diseksiyonu uygulandı. Patolojik inceleme sonucu da, PTK olarak bildirildi. Diseksiyon materyallerinde lenf nodu metastazı saptandı. Ameliyat sırası ve ameliyat sonrası erken dönemde komplikasyon gelişmedi ve ameliyat sonrası bir yıllık takip sırasında nüks veya rezidü bulgusuna rastlanmadı. Sonuç olarak, ilk trimesterde doğuştan malformasyonların riski yüksek olduğu için, yapılacak ameliyat elektif ise, ikinci trimesterde gerçekleştirilmelidir. Sonografide malign özellikler içeren ve PTK’nin İİAB ile doğrulandığı gebelere ameliyat öncesi, sırası ve sonrasında gerekli önlemler alınarak güvenle cerrahi uygulanabilir. Bu hastaların anestezisinde premedikasyon yapılmamalı, hastalara uygun pozisyon verilmeli ve teratojenik ajanlar kullanılmamalıdır. Ameliyat sonrasında anne ve fetüs yakından takip edilmelidir

Anahtar Kelimeler

Diferansiye tiroid kanseri, gebelik, tiroid cerrahisi

Kaynakça

• Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-214.
• Mazzaferri EL. Evaluation and management of common thyroid disorders in women. Am J Obstet Gynecol 1997;176:507-14.
• Moosa M, Mazzaferri EL. Outcome of differentiated thyroid cancer diagnosed in pregnant women. J Clin Endocrinol Metab 1997;82:2862-6.
• Kuczkowski KM. Nonobstetric surgery in the parturient: anesthetic considerations. J Clin Anesth 2006;18:5-7.
• Van De Velde M, De Buck F. Anesthesia for non- obstetric surgery in the pregnant patient. Minerva Anestesiol 2007;73:235-40.
• Carvalho B. Nonobstetric surgery during pregınancy. IARS 2006. 2006. [Last accessed on 25 Mar 2014]. pp. 23–30. review course lectures. Available from: http:// www.iars.org.
• Morris PC. Thyroid cancer complicating pregnancy. Obstet Gynecol Clin North Am 1998;25:401-5.
• Marley EF, Oertel YC. Fine-needle aspiration of thyroid lesions in 57 pregnant and postpartum women. Diagn Cytopathol 1997;16:122-5.
• De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012;97:2543-65.
• Messuti I, Corvisieri S, Bardesono F, Rapa I, Giorcelli J, Pellerito R, et al. Impact of pregnancy on prognosis of differentiated thyroid cancer: clinical and molecular features. Eur J Endocrinol 2014;170:659-66.
• Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011;21:1081-125.
• Fitzpatrick DL, Russell MA. Diagnosis and management of thyroid disease in pregnancy. Obstet Gynecol Clin North Am 2010;37:173-93.
• Budak A, Gulhan I, Aldemir OS, Ileri A, Tekin E, Ozeren M. Lack of influence of pregnancy on the prognosis of survivors of thyroid cancer. Asian Pac J Cancer Prev 2013;14:6941-3.
• Vannucchi G, Perrino M, Rossi S, Colombo C, Vicentini L, Dazzi D, et al. Clinical and molecular features of differentiated thyroid cancer diagnosed during pregnancy. Eur J Endocrinol 2010;162:145-51.
• Mazzaferri EL. Approach to the pregnant patient with thyroid cancer. J Clin Endocrinol Metab 2011;96:265-72.
• Kuy S, Roman SA, Desai R, Sosa JA. Outcomes following thyroid and parathyroid surgery in pregnant women. Arch Surg 2009;144:399-406.
• Stack BC Jr, Ferris RL, Goldenberg D, Haymart M, Shaha A, Sheth S, et al. American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid 2012;22:501-8.
• Carling T, Carty SE, Ciarleglio MM, Cooper DS, Doherty GM, Kim LT, et al. American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid 2012;22:237-44.
• Liao S, Shindo M. Management of well-differentiated thyroid cancer. Otolaryngol Clin North Am 2012;45:1163-79.
• Thinkhamrop J, Hofmeyr GJ, Adetoro O, Lumbiganon P. Prophylactic antibiotic administration in pregnancy to prevent infectious morbidity and mortality. Cochrane Database Syst Rev 2002;4:CD002250.
• Lu Q, Xie SQ, Chen SY, Chen LJ, Qin Q. Experience of 1166 thyroidectomy without use of prophylactic antibiotic. Biomed Res Int 2014;2014:758432.
• Kendrick JM, Neiger R. Intraoperative fetal monitoring during nonobstetric surgery. J Perinatol 2000;20:276-7.
• Lyons G, Akerman N. Problems with general anaesthesia for Caesarean section. Minerva Anestesiol 2005;71:27-38.
• Birnbach DJ, Browne IM. Anesthesia for obstetrics. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Keonish JP, Young WL, editors. Miller’s Anesthesia. 7th ed. New York: Churchill Livingstone; 2010. p. 2203-40.
• Sam S, Molitch ME. Timing and special concerns regarding endocrine surgery during pregnancy. Endocrinol Metab Clin North Am 2003;32:337-54.
• Iyilikci L, Akarsu M, Kocaayan E, Topalak O. Sedation for endoscopic retrograde cholangiopancreatography (ERCP) in a pregnant patient. J Anesth 2007;21:69-71.
• Frölich MA. Obstetric anesthesia. In: Butterworth JF, Mackey DC, Wasnick JD, editors. Clinical Anaesthesiology. 5th ed. New York: McGraw-Hill Companies; 2013. p. 825-77.
• Anderson EL, Reti IM. ECT in pregnancy: a review of the literature from 1941 to 2007. Psychosom Med 2009;71:235-42.
• Ní Mhuireachtaigh R, O’Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth 2006;18:60-6.